Relapse Of Leukemia

  A 14 year old boy is hospitalized for relapse of leukemia after a failed bone marrow transplant. The family has been told his condition is terminal, there is nothing more to be done except keep him comfortable.

His mother is distant, uncommunicative and rarely visits. When she does, she doesn’t touch Robbie or speak to him. She sits in a recliner by the window reading novels and requesting cokes multiple times per visit.

The interdisciplinary team calls a family meeting, but the mother is conspicuously absent. Robbie’s father is frantic, demanding further treatments, regardless of low likelihood of efficacy. During the family meeting, he directs the team NOT to tell Robbie he might die, as he would lose hope. He states: “In our culture, we keep this news from patients to avoid upsetting them.”

You are the nurse. When you are alone caring for Robbie, he asks you “Am I dying?”

1.  How should you respond?

2.  What are three options you could select?

3.  How does the Code of Ethics guide you in the virtue of truth-telling?

4.  Who is the authorized decision-maker in this case?

5.  What other considerations play a part in your response?

6.  What insights did you gain about a nurse’s role in end of life care where family dynamics are touchy?

7.  How does a nurse deal with conflicting opinions about a course of treatment?

8.  To whom is the nurse most accountable: the patient, the patient’s family, or the physician?

9.  How does a nurse balance these conflicting loyalties?

10. How does the Code of Ethics guide you in the spur of the moment when a response is expected momentarily? What ideas did this assignment prompt in your thinking?

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